Healthcare Provider Details

I. General information

NPI: 1316676315
Provider Name (Legal Business Name): REBECCA ANNE METZ DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REBECCA ANNE MORAVSIK DPM

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 06/07/2022
Certification Date: 05/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5105 BACKLICK RD, SUITE S
ANNANDALE VA
22003
US

IV. Provider business mailing address

PO BOX 3034
LEESBURG VA
20177-7999
US

V. Phone/Fax

Practice location:
  • Phone: 703-941-7770
  • Fax: 703-941-7771
Mailing address:
  • Phone: 703-727-6468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number0103300913
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: